Provider Demographics
NPI:1902782238
Name:BOLLONG, WILLEM JURGEN (ATP)
Entity type:Individual
Prefix:
First Name:WILLEM
Middle Name:JURGEN
Last Name:BOLLONG
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 482 UNIFORM BUSINESS OFFICE FPO, AP 96362
Mailing Address - Street 2:
Mailing Address - City:NAGO
Mailing Address - State:OKINAWA
Mailing Address - Zip Code:96362
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 482 UNIFORM BUSINESS OFFICE FPO, AP 96362
Practice Address - Street 2:
Practice Address - City:NAGO
Practice Address - State:OKINAWA
Practice Address - Zip Code:96362
Practice Address - Country:JP
Practice Address - Phone:098-971-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider